Delay in the Diagnosis of Patients With Head and Neck Cancer: Impact of Different Patient- and Healthcare Provider-Related Factors.

Background In our setup, head and neck cancer (HNC) is the most common, and patients frequently present at an advanced stage, which results in dismal outcomes. Delays on the part of the patient (such as resistance to seeking treatment) or the provider (such as misdiagnosis or an extended wait period for consultation) may be the cause of a late presentation. The presentation stage may vary depending on several factors, including age, gender, smoking status, job status, and education. Objectives The study aims to identify factors that lead to advanced-stage presentations of HNCs and to determine the delays brought on by patient- or healthcare provider-related factors and how these factors affect HNC disease staging among biopsy-proven HNC patients. Materials and methods Participants in the study were those who initially presented with a biopsy-verified HNC at the cancer clinic of the department of otolaryngology-head and neck surgery at Pakistan Institute of Medical Sciences (PIMS), Islamabad. Patients answered questions on their first symptom presentation, past healthcare professional visits, and intervals between visits on a Cancer Symptom Interval Measure (C-SIM) questionnaire. For every patient, clinical and demographic information was gathered. TNM staging was completed. The test of significance was applied where applicable. Results Age, gender, education level, and smoking status had no bearing on the presentation stage. Patients without jobs present at a statistically significant higher stage (p = 0.038). The most prevalent histological form of HNC was squamous cell carcinoma 79 (82.29%), with the oral cavity and larynx being the most common sites of the disease 30 (31.25%) and 29 (30.21%) respectively. Patients took an average of 5.28 ± 9.12 months from the onset of symptoms to their first appointment with a healthcare provider. Prior to diagnosis, the majority of patients saw three or more healthcare providers (range: 1-8). The duration from the initial visit to a healthcare provider to the initiation of treatment was 3.06 ± 5.88 months. Based on the stage at presentation, there were no discernible variations in the times to presentation (p>0.05). Conclusion Significant delays and high stage of presentation are caused by unemployment. The majority of the delay was caused by the patient's tardiness in seeing a medical practitioner, yet the presentation stage was not greatly impacted by this delay.

A New Ultrasound-Guided, One-Point, Single Interfascial Plane Botulinum Toxin A Injection Technique for the Repair of Ventral Abdominal Wall Hernias Before Surgery: A Case Report.

Patients presenting with large ventral abdominal wall hernias require pretreatment with injection botulinum toxin A before surgery. Currently, multipoint and multilayered botulinum injection techniques are practiced. We are describing a new ultrasound-guided, 1-point, single interfascial plane botulinum toxin A injection technique for the closure of big hernial defects.

Metal-Organic Framework-Derived High-Entropy Oxides as Coreaction Accelerators for an Efficient Luminol/Dissolved Oxygen Electrochemiluminescence System for Ultrasensitive Mercury Detection.

The development of luminol-dissolved O2 (luminol-DO) electrochemiluminescence (ECL) systems is crucial for real-world applications. Despite its stability and low biotoxicity, luminol-DO ECL systems struggle with low ECL performance due to their low reactivity. Investigating new materials like coreactant accelerators increases reactive oxygen species (ROS) formation and enhances luminol-DO ECL intensity. Motivated by the ROS-mediated ECL process, for the first time, we designed oxygen vacancy (OV)-rich high-entropy oxides (HEO) with five metal components [(FeCoNiCuZn)O] derived from metal-organic frameworks (MOFs) as coreaction accelerators to establish efficient luminol-DO ECL systems. High entropy (HE) MOFs were annealed at four different temperatures (600, 700, 800, and 900 °C). Indeed, the HE MOFs annealed at 800 °C (HEO-800) showed a 120-fold stronger ECL intensity compared to the bare glassy carbon electrode in the luminol-DO ECL system. The enhanced ECL performance can be attributed to the porous structure, unique morphology, heterostructures, high-density active sites, rich OV, unsaturated metals, and synergistic impact, which act as catalysts to accelerate the conversion of DO to ROS. The developed HEO-800-based luminol-DO ECL system can be effectively used for the high-sensitivity detection of mercury ions (Hg2+). The system detected Hg2+ over a wide concentration range from 0.1 nM to 100 µM, with a detection limit of 0.02 nM. The sensing mechanism relied on high-affinity metallophilic Hg2+-HEO-800 interactions, effectively quenching the ECL intensity of the luminol-DO/HEO-800 ECL system. The ECL sensing platform, developed without H2O2, offers a novel method for detecting substances, demonstrating significant potential for clinical diagnosis and biomarker analysis.

Assessing the attitudes and knowledge of medical students towards Patient-Centred Care across different study years: A cross-sectional study.

OBJECTIVE: To determine how medical students viewed the importance of patient-doctor communication, to assess their knowledge about patient-centred care, and to compare the attitudes of medical students in their pre-clinical and clinical years of study towards patient-centred care. METHODS: The cross-sectional study was conducted from April to September 2023 at Federal Medical and Dental College, Islamabad, and Rawalpindi Medical University, Rawalpindi, Pakistan, and comprised medical students of either gender from 2nd to 5th academic year. Data was collected using the Patient-Practitioner Orientation Scale. Data was analysed using SPSS 27. RESULTS: Of the 322 students, 178(55.3%) were males and 144(44.7%) were females. The mean score was 3.60±0.47, while the sharing and caring sub-scores were 3.23±0.66 and 3.99±0.52, respectively. The attitude of students overall was slightly patient-centred. Different study years showed variance in patient-centred scores which were also affected by cultural, demographic and gender parameters (p<0.05). CONCLUSIONS: The attitude of the students leaned slightly towards patient-oriented behaviour.

Emergence of symmetric and asymmetric Dirac points under periodic electric and vector potentials in ABA-trilayer graphene superlattice.

We have theoretically investigated the impact of both periodic electric and vector potentials on the low energy spectrum of ABA-trilayer graphene superlattice. Finite energy Dirac points appear in the energy spectrum due to the application of the vector potential. These extra Dirac points are symmetric about k y = 0 plane for equal barrier and well widths. For different barriers and well widths, one Dirac point shifts away and the second Dirac point shifts towards the k y = 0 plane. The extra Dirac points are not only generated from the original Dirac point but also emerge from the valleys developed in the energy spectrum. The application of both electric and vector potentials with identical barrier and well widths breaks the symmetry of the spectrum about the Fermi level. When the electric and vector potentials are asymmetric with all three layers having the same electric potentials, the energy spectrum becomes asymmetric about the Fermi level, and this asymmetric behavior of both potentials annihilates the original Dirac point from the spectrum. When all the layers have different electric potentials and both electric and vector potentials are asymmetric, the spectrum becomes asymmetric again, but this time the asymmetry of the spectrum occurs across the k y = 0 plane.

Self-Powered Electrochemiluminescence for Imaging the Corrosion of Protective Coating of Metal and Quantitative Analysis.

In almost all electrochemical systems for electrochemiluminescence (ECL) analysis, electrodes are connected with an external power source, either directly or via wireless energy transfer circuit. That is inconvenient and makes some applications impossible. Herein, we use galvanized iron with two different metals as both power source and electrodes to achieve a self-powered ECL and exploit ECL for the imaging of the corrosion of protective coating of widely used metal (e.g. galvanized iron) for the first time. The self-powered ECL enables the visualization of the deterioration of galvanic coating on iron using a smartphone and the detection of ascorbic acid with a linear range of 0.5-100 µM and a limit of detection of 0.31 µM. The devices based on self-powered approach do not require external power supply, thus effectively reducing their volume and cost. The self-powered ECL holds great promise for metal corrosion imaging and analytical applications.

Effects of Nasal Packing on Patients' Post-operative Vital Signs.

Background Since bilateral nasal packing entails nasal and airway obstruction, this practice consequently leads to oral breathing. The resulting hypoxemia may then negatively impact vital signs, including blood pressure (BP), blood oxygen saturation (SpO2), and heart rate (HR). These systemic effects have a detrimental effect on patients. Objective The objective of this study is to observe the effects of bilateral nasal packing on patients' post-operative vital signs. Materials and methods This prospective study was conducted in the department of otolaryngology - head and neck surgery over a six-month period. The study included 83 post-operative patients with nasal surgery, in which bilateral merocele nasal packing was performed. The patients' pulse oximetry, systolic and diastolic BP, and HR were recorded four times the night before and after surgery. A statistical analysis was performed, and the mean values, standard deviation, and range were calculated. A paired sample t-test was also applied. The results are presented in figures and tables. Results The mean age of the participants was 27.65 ± 10.72 years, and 56 (67.5%) were male. Septoplasty was the most common surgery performed, with 63 participants having undergone this procedure (75.9%). When the pre-operative mean values of systolic and diastolic BP, SpO2, and HR were compared with the post-operative mean values, when a bilateral nasal pack was in place, a significant increase was found in all, with a p-value of <0.001 in each. Conclusion Bilateral nasal packing affects patients' vital signs by significantly increasing diastolic and systolic BP and decreasing SpO2. The HR is also significantly increased when packing is in place.

Consensus statements for influenza awareness, prevention, and vaccination in Pakistan.

INTRODUCTION: Influenza is a serious underestimated viral infection in Pakistan and influenza vaccination and vaccination awareness are low. The current work aimed to develop consensus on influenza epidemiology, prevention, vaccination, and awareness in Pakistan. METHODOLOGY: A systematic literature search was conducted to develop recommendations on influenza vaccines in Pakistan. Experts' feedback was incorporated using the modified Delphi method. A three-step process was used, with 18 experts from different specialties from Pakistan who participated in voting rounds to achieve a minimum 75% agreement level. RESULTS: Pakistan has a low-immunization-rate and is susceptible to serious influenza outbreaks and influenza-related complications. Influenza circulates year-round in Pakistan but peaks during January and February. The subtype A/H1N1 is predominant. The experts urged vaccination in all individuals ≥ 6 months of age and with no contraindications. They highlighted special considerations for those with comorbidities and specific conditions. The experts agreed that the inactivated influenza vaccine is safe and efficient in pregnant women, immunocompromised, and comorbid respiratory and cardiovascular patients. Finally, the experts recommended conducting promotional and educational programs to raise awareness on influenza and vaccination. CONCLUSIONS: This is the first regional consensus on influenza and influenza vaccination in Pakistan with experts' recommendations to increase influenza vaccination and decrease influenza cases and its associated detrimental effects.

Highly Sensitive Diethylamine Detection at Room Temperature Using g-C3N4 Nanosheets Decorated with CuO Hollow Polyhedral Structures.

Chemiresistive-based metal oxide semiconductor (MOS) gas sensors are widely used in gas sensing due to their advantageous properties. Graphitic carbon nitride (g-C3N4) and metal oxide heterostructure materials can improve charge transport properties, selectivity, and sensitivity in MOS gas sensor materials. Herein, for the first time, CuO hollow polyhedral structures (HPSs) were synthesized via a hydrothermal technique and annealed at different temperatures, with the 400 °C annealed (CuO-400 HPSs) demonstrating remarkable sensing capabilities for diethylamine (DEA) gas at room temperature (RT). The x-g-C3N4 nanosheets were decorated with CuO HPSs in varying amounts (x = 0.8, 1.8, 2.1, and 3.1 wt %) and then annealed at 400 °C for x-g-C3N4-CuO-400 hollow polyhedral heterostructures (HPHSs). Indeed, among the synthesized samples, the 1.8%-g-C3N4-CuO-400 HPHSs have a higher sensitivity to DEA (resistance change in gas (Rg) and air (Ra); Rg/Ra= 65 @ 20 ppm), a low detection limit (Rg/Ra= 6 @ 500 ppb), wide dynamic response (Rg/Ra= 190 @ 80 ppm), strong stability (30 days), and 21.6 times higher sensitivity than pure CuO at RT toward 20 ppm of DEA. The exceptional gas-sensing behavior can be attributed to various factors, including controlled annealing conditions that result in the formation of well-defined structures and greater porosity, efficient charge transfer properties resulting from an optimized ratio of g-C3N4 to CuO in HPHSs, an abundance of defects, unsaturated Cu sites, and synergistic effects. The study presents a universal strategy for generating sensitive and selective g-C3N4-based composite materials for low-temperature gas sensors.

Boosting Electrochemiluminescence Performance of a Dual-Active Site Iron Single-Atom Catalyst-Based Luminol-Dissolved Oxygen System via Plasmon-Induced Hot Holes.

Due to the commonly low content of biomarkers in diseases, increasing the sensitivity of electrochemiluminescence (ECL) systems is of great significance for in vitro ECL diagnosis and biodetection. Although dissolved O2 (DO) has recently been considered superior to H2O2 as a coreactant in the most widely used luminol ECL systems owing to its improved stability and less biotoxicity, it still has unsatisfactory ECL performance because of its ultralow reactivity. In this study, an effective plasmonic luminol-DO ECL system has been developed by complexing luminol-capped Ag nanoparticles (AgNPs) with plasma-treated Fe single-atom catalysts (Fe-SACs) embedded in graphitic carbon nitride (g-CN) (pFe-g-CN). Under optimal conditions, the performance of the resulting ECL system could be markedly increased up to 1300-fold compared to the traditional luminol-DO system. Further investigations revealed that duple binding sites of pFe-g-CN and plasmonically induced hot holes that disseminated from AgNPs to g-CN surfaces lead to facilitate significantly the luminous reaction process of the system. The proposed luminol-DO ECL system was further employed for the stable and ultrasensitive detection of prostate-specific antigen in a wide linear range of 1.0 fg/mL to 1 µg/mL, with a pretty low limit of detection of 0.183 fg/mL.

Transition metal-based electrocatalysts for alkaline overall water splitting: advancements, challenges, and perspectives.

Water electrolysis is a promising method for efficiently producing hydrogen and oxygen, crucial for renewable energy conversion and fuel cell technologies. The hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) are two key electrocatalytic reactions occurring during water splitting, necessitating the development of active, stable, and low-cost electrocatalysts. Transition metal (TM)-based electrocatalysts, spanning noble metals and TM oxides, phosphides, nitrides, carbides, borides, chalcogenides, and dichalcogenides, have garnered significant attention due to their outstanding characteristics, including high electronic conductivity, tunable valence electron configuration, high stability, and cost-effectiveness. This timely review discusses developments in TM-based electrocatalysts for the HER and OER in alkaline media in the last 10 years, revealing that the exposure of more accessible surface-active sites, specific electronic effects, and string effects are essential for the development of efficient electrocatalysts towards electrochemical water splitting application. This comprehensive review serves as a guide for designing and constructing state-of-the-art, high-performance bifunctional electrocatalysts based on TMs, particularly for applications in water splitting.

Steering the Selective Production of Glycolic Acid by Electrocatalytic Oxidation of Ethylene Glycol with Nanoengineered PdBi-Based Heterodimers.

Heterodimers of metal nanocrystals (NCs) with tailored elemental distribution have emerged as promising candidates in the field of electrocatalysis, owing to their unique structures featuring heterogeneous interfaces with distinct components. Despite this, the rational synthesis of heterodimer NCs with similar elemental composition remains a formidable challenge, and their impact on electrocatalysis has remained largely elusive. In this study, Pd@Bi-PdBi heterodimer NCs are synthesized through an underpotential deposition (UPD)-directed growth pathway. In this pathway, the UPD of Bi promotes a Volmer-Weber growth mode, allowing for judicious modulation of core-satellite to heterodimer structures through careful control of supersaturation and growth kinetics. Significantly, the heterodimer NCs are employed in the electrocatalytic process of ethylene glycol (EG) with high activity and selectivity. Compared with pristine Pd octahedra and common PdBi alloy NC, the unique heterodimer structure of the Pd@Bi-PdBi heterodimer NCs endows them with the highest electrocatalytic performance of EG and the best selectivity (≈93%) in oxidizing EG to glycolic acid (GA). Taken together, this work not only heralds a new strategy for UPD-directed synthesis of bimetallic NCs, but also provides a new design paradigm for steering the selectivity of electrocatalysts.

Recent developments and challenges in resistance-based hydrogen gas sensors based on metal oxide semiconductors.

In recent years, the energy crisis has made the world realize the importance and need for green energy. Hydrogen safety has always been a primary issue that needs to be addressed for the application and large-scale commercialization of hydrogen energy, and precise and rapid hydrogen gas sensing technology and equipment are important prerequisites for ensuring hydrogen safety. Based on metal oxide semiconductors (MOS), resistive hydrogen gas sensors (HGS) offer advantages, such as low cost, low power consumption, and high sensitivity. They are also easy to test, integrate, and suitable for detecting low concentrations of hydrogen gas in ambient air. Therefore, they are considered one of the most promising HGS. This article provides a comprehensive review of the surface reaction mechanisms and recent research progress in optimizing the gas sensing performance of MOS-based resistive hydrogen gas sensors (MOS-R-HGS). Particularly, the advancements in metal-assisted or doped MOS, mixed metal oxide (MO)-MOS composites, MOS-carbon composites, and metal-organic framework-derived (MOF)-MOS composites are extensively summarized. Finally, the future research directions and possibilities in this field are discussed.

Comparison Between Complications of Elective and Emergency Tracheostomies.

Introduction Tracheostomy, although a common surgical procedure, is associated with potential complications. Complications can be avoided with accurate technique and proper operative and postoperative care. A surgeon should know the complications of the procedure and how to avoid them so that complications may be prevented or minimized. Objective To determine the frequency of complications in patients undergoing elective and emergency tracheostomies. Methods The cross-sectional study was conducted at the Department of Otorhinolaryngology - Head and Neck Surgery, and Intensive Care Unit (ICU) of PIMS Hospital, Islamabad, from March 1 to August 31, 2023, with a total duration of six months. A total of 110 patients admitted to the ICU and presented in an emergency falling within the inclusion criteria were counted in the study. Patients were split into two groups, i.e., elective tracheostomy (group A) and emergency tracheostomy (group B). All patients were followed for three months for adverse events related to the tracheostomy. All information was collected on Proforma and analyzed using the SPSS 23 version (IBM Corp., Armonk, NY). Results The mean age of participants was 48.47±12.68 years in group A and 49.54±10.99 years in group B (p=0.636). 40 (72.7%) and 37 (67.3%) patients were male and 15 (27.3%) and 18 (32.7%) female in groups A and B, respectively. The results of post-operative complications in both groups A and B were observed, respectively, for surgical emphysema (2 [3.6%] vs. 5 [9.1%], p=0.241), hemorrhage (2 [3.6%] vs. 4 [7.3%], p=0.401), wound infection (3 [3.6%] vs. 6 [10.9%], p=0.279), tube blockage (0 [0.0%] vs. 1 [1.8%], p=0.315), tube displacement (0 [0.0%] vs. 3 [5.5%], p=0.079), and tracheoesophageal fistula (0 [0.0%] vs. 2 [3.6%], p=0.154). The overall complications in elective tracheostomies were 7 (12.7%) and in emergency tracheostomies were 21 (38.2%). Conclusion We concluded that patients who had an emergency tracheostomy experienced more postoperative complications than those who underwent an elective tracheostomy.

Ultrafast Response and High Selectivity of Diethylamine Gas Sensors at Room Temperature Using MOF-Derived 1D CuO Nano-Ellipsoids.

Environmental and health monitoring requires low-cost, high-performance diethylamine (DEA) sensors. Materials based on metal-organic frameworks (MOFs) can detect hazardous gases due to their large specific surface area, many metal sites, unsaturated sites, functional connectivity, and easy calcination to remove the scaffold. However, developing facile materials with high sensitivity and selectivity in harsh environments for accurate DEA detection at a low detection limit (LOD) at room temperature (RT) is challenging. In this study, p-type semiconducting porous CuOx sensing materials were synthesized using a simple solvothermal process and annealed in an argon atmosphere at three different temperatures (x = 400, 600, and 800 °C). Significant variations in particle size, specific area, crystallite size, and shape were noticed when the annealing temperature was elevated. Cu-MIL-53 annealed at 400 °C (CuO-400) has a typical nanoellipsoid (NEs) shape with a length of 61.5 nm and a diameter of 33.2 nm. Surprisingly, CuO-400 NEs showed an excellent response to DEA with an ultra-LOD (Rg/Ra = 7.3 @ 100 ppb, 55% relative humidity), excellent selectivity and sensitivity (Rg/Ra = 236 @ 15 ppm), exceptional long-term stability and repeatability, and a fast response/recovery period at RT, outperforming most previously reported materials. CuO-400 NEs have outstanding gas-sensing characteristics due to their high porosity, 1D nanostructure, unsaturated Cu sites (Cu+ and Cu2+), large specific surface area, and numerous oxygen vacancies. This study presents a generic approach to produce future CuO derived from Cu-MOFs-sensitive materials, revealing new insights into the design of effective sensors for environmental monitoring at RT.

Do age, gender, BMI and disease duration influence the clinical outcomes in patients of knee osteoarthritis treated with serial injections of autologous platelet rich plasma?

Purpose: To study whether age, gender, body mass index(BMI) and disease duration influence the clinical outcomes in kellgren-Lawrence(K-L) grade II,III knee osteoarthritis(KOA) patients treated with serial injections of platelet rich plasma(PRP). Patients and methods: 65 patients were given three monthly intra-articular injections of PRP in this prospective interventional study. The patients were divided into subgroups depending on the factor studied: by age(in years) into young <45(n = 7), middle age 45-60(n = 35), and elderly >60(n = 23): by BMI(in kg/m2) into; normal <25(n = 25), overweight 25-30(n = 27) and obese >30(n = 13) and disease duration; less(n = 32) or more than 1 year(n = 33) symptom duration. Visual analogue scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used as outcome measures and assessed before each injection and then at 6 and 9 months post injection. Groups were homogenous with respect to baseline characteristics. Results: Mean VAS and WOMAC scores showed a statistically significant improvement (P < 0.0001) across all groups and subgroups (age,gender,BMI,disease duration) at follow up. On intra-subgroup comparison, we found no significant differences(P > 0.05) among age, BMI or gender subgroups, however the scores were significantly better in patients with disease duration of less than 1 year than those with more than 1 year duration at both 6 and 9 months[P < 0.001(RC = 9.630,95% CI = 4.037-15.222,P = 0.001)]. Conclusion: PRP injections if given serially can improve the short term subjective scores of VAS and WOMAC scores in patients with K-L grade II and III KOA irrespective of age, gender, BMI or disease duration, however, clinical benefits can be maximized if given early in the disease course.

Advancements in Neighboring-Based Energy-Efficient Routing Protocol (NBEER) for Underwater Wireless Sensor Networks.

Underwater wireless sensor networks (UWSNs) have gained prominence in wireless sensor technology, featuring resource-limited sensor nodes deployed in challenging underwater environments. To address challenges like power consumption, network lifetime, node deployment, topology, and propagation delays, cooperative transmission protocols like co-operative (Co-UWSN) and co-operative energy-efficient routing (CEER) have been proposed. These protocols utilize broadcast capabilities and neighbor head node (NHN) selection for cooperative routing. This research introduces NBEER, a novel neighbor-based energy-efficient routing protocol tailored for UWSNs. NBEER aims to surpass the limitations of Co-UWSN and CEER by optimizing NHNS and cooperative mechanisms to achieve load balancing and enhance network performance. Through comprehensive MATLAB simulations, we evaluated NBEER against Co-UWSN and CEER, demonstrating its superior performance across various metrics. NBEER significantly maximizes end-to-end delay, reduces energy consumption, improves packet delivery ratio, extends network lifetime, and enhances total received packets analysis compared to the existing protocols.

Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar radiculopathy: A Prospective, Double-Blind Randomized Study.

Purpose: To evaluate and compare the clinical efficacy of transforaminal steroid and platelet-rich plasma (PRP) injections in patients with discogenic lumbar radiculopathy. Methods: 60 patients were randomized to be treated with single transforaminal injection of PRP (n = 29) or steroid (methylprednisolone acetate [n = 31]). Clinical assessment was done with Visual analogue scale (VAS), modified Oswestry low back pain disability index (MODI), and straight leg raise test (SLRT). Baseline assessment of outcomes was done followed by post-intervention evaluation at 1, 3, and 6 months. Both groups had similar baseline characteristics. Results: There was a significant statistical improvement of VAS and MODI in both groups at follow-up (P < 0.05). In PRP group, minimal clinically important change (> 2 cm difference of mean for VAS and > 10-point change in MODI) for both outcome scores was achieved at all follow-up intervals (1, 3, 6 months), while as in steroid group, it was seen only at 1 and 3 months for both VAS and MODI. On intergroup comparison, better results were seen in steroid group at 1 month (P < 0.001 for both VAS and MODI), and in PRP group at 6 months (P < 0.001 for both VAS and MODI) with non-significant difference at 3 months (P = 0.605 for MODI and P = 0.612 for VAS). More than 90% tested SLRT negative in PRP group and 62% in steroid group at 6 months. No serious complications were seen. Conclusion: Transforaminal injections of PRP and steroid improve short-term (up to 3 months) clinical outcome scores in discogenic lumbar radiculopathy, but clinically meaningful improvements sustaining for 6 months were provided by PRP only.

Serial intraarticular injections of growth factor concentrate in knee osteoarthritis: A placebo controlled randomized study.

Objective: To evaluate and compare clinical efficacy and effect on specific serum biomarker with serial injections of growth factor concentrate (GFC) for knee osteoarthritis (KOA) in a randomized triple blinded placebo controlled interventional study. Methods: Final assessment was done on 58 patients. Patients with Kellgren-Lawrence grade II, III knee osteoarthritis were administered monthly intraarticular injections(3 injections) of GFC(n = 31) or saline(n = 27) and evaluated clinically with visual analogue scale(VAS) and Western Ontario and McMaster Universities Arthritis Index(WOMAC) at 3,6 and 12 months post therapy. Biochemical analysis was done with serum biomarker of cartilage degeneration, Collagen 2-1 (Coll2-1), estimated at baseline and at final follow up. Results: Both the groups exhibited statistically significant improvements (P < 0.05) in VAS at 3,6 and 12 months. WOMAC improvement reached statistical significance for GFC group at every evaluation (P < 0.001) but only at 12 months in NS group (P = 0.029). The improvements were clinically meaningful only in GFC group throughout follow up (Minimal clinically important differences >12% of baseline in WOMAC and >2 cm difference in mean for VAS). Intergroup comparison revealed GFC to be much better for both scores at every evaluation (95% CI of 0.2-1.5,[P = 0.008], 1.4-2.9,[P < 0.0001], and 2.7-4.2,[P < 0.0001] for VAS, 7.3-16.0 [P < 0.001], 11.6-21.9 [P < 0.001] and 18.1-31.1[P < 0.001] for WOMAC). Statistically significant decrease in serum Coll2-1 levels were observed for GFC group only. No serious complications were seen. Conclusion: Serial(three) monthly GFC injections result in clinically meaningful improvement of subjective pain and function outcome scores, sustaining up to 12 months in KOA grade II and III. GFC also lead to significant reduction in serum levels of cartilage degradation biomarker coll2-1.